New RA Diagnosis: The First Medication

Treatment for rheumatoid arthritis (RA) aims to control inflammation, slow damage to your joints and prevent damage to your organs. For some people, this means remission – being symptom-free. For others, the goal is low disease activity, where symptoms are minimal. Working together, you and your doctor will decide how to get there.

The first medicines your doctor may recommend are:

• Methotrexate. This is a disease-modifying antirheumatic drug (DMARD) that will reduce inflammation and slow down the disease. It takes a while to work. It is taken by pill or injection once a week. 
• NSAIDs. A nonsteroidal anti-inflammatory, such as ibuprofen (Advil) or naproxen (Aleve), ease pain and inflammation while you wait for the methotrexate to work.
• Steroids. A glucocorticoid, like prednisone, may be given in pill form to fight inflammation and pain while waiting for methotrexate to work.

Methotrexate can cause side effects, including mouth sores, nausea and diarrhea. Some people have less stomach upset with injections than with pills. Talk to your doctor about side effects and what you can do to lessen them. 
It takes six to eight weeks for methotrexate to start working. It can take up to six months to feel the full benefits. 
 

Methotrexate is safe and effective for many people with RA. But it doesn’t work for everyone. In that case, your doctor may add another DMARD (such as sulfasalazine) or even a third (usually hydroxychloroquine). 

Stronger drugs, called biologics, are rarely the first ones tried. They are used if other treatments don’t work well enough.
 

Your doctor may talk to you about a treatment approach called treat-to-target (T2T). It’s the recommended way to treat RA. In T2T, you and your doctor decide on a treatment goal, or target, with certain milestones along the way. Then you check in with your doctor every few months to see if you’ve reached your mini-goals. Your treatment will change if those goals are not met. Your input in this process is essential. It’s up to you and your doctor to decide what you want to achieve with your treatment and the best way to do it